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f= SAN JOAQUIN Environmental Health Department <br /> Vii: `; —COUNTY <br /> Greatness grows here. <br /> Q Monitoring Well/Soil Boring Inspection Report <br /> Date:-3 / In ector: ��A CONSTRUCTION <br /> Facility Address: 150 �. S�N G�D�r/" SVG <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: A I Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: u TeFilter Pack From: To: <br /> Geologist: �<M F ,,f o ri S 1 <br /> leJ' I Bentonite From: To: <br /> t!�yS �1/ec fed by dr, Ilo-f- Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 3iff height <br /> SAMPLING ABOVE-GRCUND cHRLSTY eox <br /> Holding Temperature: COMPLETION cc#APLffn0N <br /> Method: Ground Surlacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —it• <br /> n. <br /> tt. <br /> SPOILS <br /> l I a <br /> e <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: allotted <br /> sac�on <br /> Covered: ❑ Yes El No <br /> 9-61 Pack <br /> If yes, material: =_ <br /> GROUTING or DESTRUCTION Total Depth: 4. EE <br /> Depth to Water: n• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: IOU qxllowS <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 5?Boring Destruction Bags of Cement: <br /> METHOD USED ("U _ i Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity E�Tremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest itBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 60 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />